Nonoccupational Physical Activity by Degree of Urbanization and U.S. Geographic Region


Medicine & Science in Sports & Exercise: December 2004 - Volume 36 - Issue 12 - pp 2093-2098
Basic Sciences: Epidemiology

Purpose: To estimate levels of nonoccupational leisure-time physical activity (LTPA) by degree of urbanization and geographic region of the United States.

Methods: Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 (N = 137,359). Moderate- and vigorous-intensity LTPA was categorized as meeting recommended levels, insufficient, or inactive. The U.S. Department of Agriculture rural-urban continuum codes were used to describe degrees of urbanization (metro, large urban, small urban, and rural). Geographic regions were defined by the U.S. Bureau of the Census (Northeast, Midwest, South, and West). Prevalence estimates were calculated using sample weights to account for the design of the BRFSS. Multivariate logistic regression analyses examined regional differences in the odds of physical inactivity (physically inactive vs insufficient or meets) by degree of urbanization after adjustment for sex, age, race, BMI, education, and occupational physical activity.

Results: Large urban areas (49.0%) and the western United States (49.0%) had the highest prevalence of recommended levels of LTPA. Rural areas (24.1%) and the southern United States (17.4%) had the highest prevalence of inactivity. Adults living in the four urbanization categories of the midwestern (metro (OR = 1.47, 95% CI = 1.31, 1.65), large urban (OR = 1.83, 95% CI = 1.51, 2.23), small urban (OR = 1.99, 95% CI = 1.65, 2.40), and rural (OR = 2.59, 95% CI = 1.35, 4.97)); and southern (metro (OR = 1.70, 95% CI = 1.53, 1.88), large urban (OR = 2.04, 95% CI = 1.72, 2.41), small urban (OR = 2.32, 95% CI = 2.02, 2.67), and rural (OR = 5.49, 95% CI = 2.82, 10.68)) U.S. regions were more likely to be inactive than adults living in similar areas of the western United States. Adults in northeast metro and large urban areas (OR = 1.62, 95% CI = 1.45, 1.81; and OR = 1.37, 95% CI = 1.08, 1.74, respectively) were more likely to be inactive than those residing in western metro and large urban areas.

Conclusion: The prevalence of physical inactivity varies by degree of urbanization and geographic region of the United States.

1Division of Epidemiology & Biostatistics, Graduate School of Public Health, and 2Department of Exercise and Nutritional Sciences, College of Professional Studies and Fine Arts, San Diego State University, San Diego, CA; 3Department of Epidemiology and Biostatistics and 4Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC; 5Schiefelbusch Institute for Life Span Studies, Center for Physical Activity & Weight Management, University of Kansas, Lawrence, KS; and 6Urban Health Institute, Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Address for correspondence: Heather Bowles, M.S., Prevention Research Center, University of South Carolina, 730 Devine St., Columbia, SC 29208; E-mail:

Submitted for publication October 2003.

Accepted for publication July 2004.

©2004The American College of Sports Medicine